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Crossing a Cultural Divide to Care for Those in Need

Urologist resident Dr. May Jean Counsilman fulfilled a lifelong goal on an international medical mission trip to Uganda.

Dr. May Jean Counsilman’s life took an interesting turn at the age of five – when she moved with her family from the bucolic surroundings of Glastonbury, Connecticut to the vertical sprawl of China’s largest city – Shanghai.

She had no way of knowing, but the move – and its ensuing cultural shift – would play a major role in the way she approached the world – and her work – as an adult.

So when she was offered an opportunity to join an international medicine mission to Uganda last October, she jumped at the chance. “Participating in international medicine and surgery has been a goal of mine since I first started the long road of training in medicine,” says Dr. Counsilman a urology resident at Thomas Jefferson University Hospital. “It was something that always sounded really interesting – to see what other countries’ health systems are like.”

A team of doctors in Uganda

The trip was underwritten by the Mid-Atlantic Section of the American Urological Association, making it possible for Dr. Counsilman to serve as an International Volunteers in Urology (IVUmed) Resident Scholar. Led by Dr. Eric Richter, a urologist based in Pueblo, CO, the two-week mission was split between Fort Portal Regional Referral Hospital in Fort Portal, Uganda and Mount Elgon Hospital in Mbale. While the facilities may have lacked some of the modern advancements that the fifth-year Department of Urology resident is accustomed to at Jefferson, her time in Uganda was no less educational, for her and her Ugandan colleagues.

Performing open prostatectomies, for example, no longer a common practice in the U.S. is a procedure American medical residents rarely experience. As part of a team of physicians in Uganda, Dr. Counsilman performed several, along with a range of cases that included transurethral resection of the prostate (TURP), transurethral resection of bladder tumor (TURBT), urethroplasties, chordee repairs and hydrocelectomies.

“Doing the TURPs was really what the local residents and fellows we worked with really wanted to see because endoscopy for them is relatively new,” says Dr. Counsilman. “As a U.S. resident, we do these all the time; I’ve done a ton of them. So it was an interesting experience to be working with Ugandan surgeons who I’m teaching how to do this operation. The exchange of knowledge was really rewarding.”

Working in an international setting was almost a given. Dr. Counsilman’s mother is from China and she has half-sisters – one of whom is also a physician – who grew up in the Netherlands, where she visited frequently. “Talking to my half-sister about medicine from a different cultural perspective definitely encouraged my interest in international medicine – as well as my appreciation for different cultures and customs around me.”

Dr. Counsilman with colleagues posing for a photograph with a waterfall in the background

While in Fort Portal, Dr. Counsilman said the visiting physicians, all of whom donate their time to aid patients in need, had an outstanding support team. It included Ugandan urologist Dr. Fred Kirya, American anesthesiologist Dr. Edward Cobb, local general surgeon Dr. Edwin Musinguzi, multiple medical staff officers, anesthetists, OR nurses and medical students. “Having so much local support allowed us to help between eight and ten patients every day,” says Dr. Counsilman. “I love the way it was set up to efficiently help as many as we could.”

In the weeks leading up to the Americans’ arrival, the Ugandan team organized a series of clinics to pre-screen patients. Once they arrived, Dr. Counsilman and her colleagues examined patients, reviewed imagery and scheduled them for surgery. Postoperatively, patients were admitted to the general wards and monitored by nursing and their own family members. “To my surprise, no one developed infections, required transfusions post operatively, or barely even complained of bladder spasms,” recalls Dr. Counsilman.

After an eight-hour ride to Mbale, in eastern Uganda, Dr. Counsilman spent the next week at Mount Elgon Hospital, a private hospital that “ran at a little slower pace” than the free, government-run hospital in Fort Portal. The lighter case load provided more time for teaching and the team worked closely with a young urologist who had recently finished a urology fellowship in Tanzania and returned to Uganda to practice. “For these physicians, it’s harder to get all of the continuing education lectures that we’re so used to here,” says Dr. Counsilman. “I gathered a ton of PowerPoints from all my colleagues and attendings to bring over for them.”

Over the final two days, the team traveled to Kampala, the Ugandan capital, to meet with a urology residency to discuss future partnerships with IVUmed. Dr. Counsilman gave several lectures to general surgery residents, urology fellows and medical students, discussing topics such as noninvasive and muscle-invasive bladder cancer, surgical stone treatment and posterior urethral valves.

A picturesque scene of Uganda

“What I came away with from the trip is how much I respect the physicians there,” says Dr. Counsilman. “They are so incredibly smart and talented and want what’s best for their patients and they have to learn about all these things that are available in other parts of the world. It made me respect them even more for being doctors in much more difficult circumstances than we have in the U.S.”

Leaving the comparatively comfortable and well-resourced environs to educate clinicians and care for the underserved a world away – as demonstrated by dozens of physicians like Dr. Counsilman – is part of Jefferson’s DNA.

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